I just had orientation and learned that we'll have 180 hrs of clinicals first semester that are randomly chosen for us. Second semester, we get a choice between various types of surgery and general medicine at a couple different hospitals. Third and fourth semester we have a wide range of options (I'll be able to choose inpatient psychiatry first semester and outpatient psych/substance abuse the next, since my interest is mental health). We rank our choices for clinicals and hopefully get our top choice (though, if your top choice is peds it's less likely you'll get it, since so many people want peds).
How does this work at your schools